‘What should we do?’ navigating the complexities of implementing comprehensive sexuality education in Zambia – a realist-informed study

Abstract

Abstract Introduction Although the outcomes of comprehensive sexuality education are generally promising and positive, limited research has been conducted on how and under what conditions these outcomes are achieved. This article analyses the contextual factors that underpin mechanisms influencing the implementation and outcomes of comprehensive sexuality education. Methods Using the realist evaluation approach, data collection and analysis were conducted iteratively, beginning with an existing program theory, followed by a literature review and then primary data collection through four realist workshops with 50 stakeholders (including trained teachers and staff from the training college, district, and provincial offices) and 60 learners. Thematic analysis, informed by realist evaluation of demi-regularities, was used. Findings We identified three key demi-regularities centred on the mechanisms of autonomy, curiosity, fear, and juggling. These are the ‘autonomy to make the right decision,’ ‘curiosity to learn about and explore adolescents’ sexuality,’ ‘fear in adolescents’ and young people’s sexual health related to the negative consequences of sex, fear of judgment and stigma for being sexually active, and fear that CSE might undermine traditional cultural values,’ and the juggling of various mechanisms, contextual conditions, and sources of information. The study highlights that while comprehensive sexuality education seeks to empower learners, this empowerment was constrained because topics were taught selectively, particularly in more contentious areas such as sexual relationships, gender identity, condom and contraception use, and abortion, due to broader societal, cultural, and religious influences. Conclusion To fully realize the benefits of comprehensive sexuality education, an approach that is holistic and also sensitive to culture and religion is needed. This approach should enable adolescents and young people to explore all aspects of sexual and reproductive health and rights while making informed decisions without undue pressure or fear.